摘要
目的比较绿激光解剖性汽化切除术(AVIT)和选择性光汽化术(PVP)治疗良性前列腺增生的效果与安全性。方法纳入2019年11月至2020年9月在苏州大学附属第二医院接受前列腺绿激光手术的患者136例,年龄53~85岁。前列腺体积30~104 ml。采用随机数字表法分成两组,其中68例行AVIT(纳入观察组),68例行PVP(纳入对照组)。收集两组患者术前、术中及术后的临床资料,并进行比较分析。结果两组手术均顺利完成。术后6个月,观察组和对照组分别有63例和66例完成随访。两组患者术前高血压、糖尿病、冠状动脉粥样硬化性心脏病、心房颤动及肾功能不全的患病率差异均无统计学意义(均P>0.05)。两组患者术前年龄[(66.8±6.5)比(67.3±5.4)岁]、国际前列腺症状评分(IPSS)[(24.2±4.7)比(23.5±4.5)分]、生活质量评分(QOL)[4.7(4.1,4.9)比4.6(4.2,5.0)分]、最大尿流率(Qmax)[(6.9±2.8)比(6.8±2.6)ml/s]、残余尿量(PVR)[(137(52.8,190.9)比119(70.6,172.1)ml]、前列腺体积(PV)[70.5(60.6,80.9)比68.2(61.2,80.5)ml]、血清前列腺特异性抗原(PSA)[4.4(3.5,5.1)比4.4(3.4,5.0)ng/ml]差异均无统计学意义(均P>0.05)。两组患者术中出血量、术后留置尿管时间和术后住院时间差异均无统计学意义(均P>0.05)。相比对照组,观察组手术时间和激光持续时间更长[69.0(64.6,75.0)比55.8(49.1,63.4)min,(36.3±9.9)比(31.3±9.3)min],术中激光能耗与能量密度更高[(297±20)比(240±20)kJ,(4.50±1.35)比(3.73±1.17)kJ/ml],差异均有统计学意义(均P<0.05)。术后1、3和6个月随访时,观察组IPSS、QOL低于对照组,差异有统计学意义(P<0.05);尿动力学参数方面,观察组Qmax高于对照组,PVR低于对照组,差异均有统计学意义(P<0.05)。术后6个月随访时,观察组PV、PSA较对照组有更大幅度下降(56%比47%、70%比60%),差异均有统计学意义(均P<0.05)。两组患者术后均无尿道狭窄、尿失禁发生。观察组患者尿路刺激征发生率为6.3
Objective To prospectively compare the efficacy and safety of the greenlight laser anatomical vaporization-incision technique(AVIT)and photoselective vaporization of the prostate(PVP)in the treatment of benign prostatic hyperplasia(BPH).Methods From November 2019 to September 2020,a randomized controlled study was conducted on 136 BPH patients undergoing greenlight laser surgery in the Department of Urology,the Second Affiliated Hospital of Soochow University.The patient′s age ranged from 53 to 85 years and the prostatic volume ranged from 30 to 104 ml.They were divided into two groups by random number table method,including 68 cases of AVIT(observation group)and 68 cases of PVP(control group).The clinical data of the two groups before,during and after operation were collected and analyzed.Results Operations were successfully completed in the two groups.At 6 months after operation,63 cases in the observation group and 66 cases in the control group completed the follow-up.There was no significant difference in the prevalence of hypertension,diabetes,coronary heart disease,atrial fibrillation and renal insufficiency between the two groups before operation(all P>0.05).The differences of preoperative age[(66.8±6.5)vs(67.3±5.4)years],international prostate symptom score(IPSS)[(24.2±4.7)vs(23.5±4.5)],quality of life score(QOL)[4.7(4.1,4.9)vs 4.6(4.2,5.0)],peak urinary flow rate(Qmax)[(6.9±2.8)vs(6.8±2.6)ml/s],post-void residual volume(PVR)[(137(52.8,190.9)vs 119(70.6,172.1)ml],prostate volume(PV)[70.5(60.6,80.9)vs 68.2(61.2,80.5)ml],serum prostate specific antigen(PSA)[4.4(3.5,5.1)vs 4.4(3.4,5.0)ng/ml]were not statistically significant between the two groups(all P>0.05).There was no significant difference in the amount of intraoperative blood loss,catheterization time and the postoperative hospitalization time between the two groups(all P>0.05).Compared with the control group,the operation time and lasing time of the observation group were longer[69.0(64.6,75.0)vs 55.8(49.1,63.4)min,(36.3±9.9)vs(31.3±9.3)min]
作者
胡广漠
严于昊
徐明
刘晓龙
陶伟
薛波新
Hu Guangmo;Yan Yuhao;Xu Ming;Liu Xiaolong;Tao Wei;Xue Boxin(Department of Urology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2022年第4期267-272,共6页
National Medical Journal of China
关键词
前列腺增生
绿激光
解剖性汽化切除术
选择性光汽化术
疗效
Prostatic hyperplasia
Greenlight laser
Anatomical vaporization-incision technique
Photoselective vaporization of the prostate
Efficacy
